Newborn call parameters

[Elvish, BSN, DNP, RN, NP]

Hi friends,

I'm just wondering....do your normal newborn orders include a set of vital sign call parameters?

Ours don't, and I've thought about it for a while now. We all know what normal VS are, and I'd like to think we'd all call for an axillary temp of 101 or something. But what about 99.4? I've gotten chewed out for calling, because some peds/NPs don't care, and others want to know and give orders (ranging anywhere from 'recheck hourly x 3 and call for XYZ temps' to full septic workups. Overkill, but I digress.) As well, all of us know that those 'borderline' VS can be indicative of a problem, or they can be outliers and mean nothing at all.

As well, our parameters for hypoglycemia are not well-defined past 24 hours. I happen to know, because I spend a lot of time in the nursery, that our neos have different standards for hypoglycemia depending on age. What's acceptable in the first few hours isn't acceptable at 24hrs of age. But we have a fair number of nurses who don't spend a lot of time in there and don't have a chance to have their ears on the ground for what peds deems appropriate at a given age.

I'm just curious to see what other places are doing before bringing this up to anyone at work. So....what do your orders say, if anything at all?

[BSNbeauty, BSN, RN]

We do have parameters for V/S and BGL and etc. However, each NNP is different and some want to be notified if they are just outside of the parameters and some don't. For example, one NNP wants to be notified of a BGL of 43 and another does not. Our policy is to call if BGL is not above 35.

This gets really confusing for me as I'm new to mother/baby. My motto is, when in doubt call. If I get chewed out, my feelings are not hurt. It is better to be safe than sorry.

[Jolie, BSN]

You mention that parameters for hypoglycemia are not well defined beyone 24 hours of age. I question why blood sugars are being done on stable, healthy newborns over a day old. That seems excessive to me, unless these are kiddos who started out with blood sugar issues and are still being monitored. If that's the case, the provider ought to be writing specific orders for continued monitoring, not expecting the nursing staff to rely on policies, procedures and protocols that were intended for the period immediately following birth.

[Elvish, BSN, DNP, RN, NP]

We don't do blood sugars on normal healthy kids as a matter of routine. We can, however, check one if the kid is overly lethargic, cold, or jittery. And what would be fine at a few hours after birth is not necessarily fine if the kid is over 24 hours. So, say I have a kid that's 26 hours old and I notice when I do his PKU that he's really jittery. I check a sugar and it's 42. Our orders only have call parameters for the first several hours after birth. 42 is fine in the first 24 hours but beyond that, our neos like them to be above 60. However, there is nothing written anywhere for anyone to know it; the knowledge is word-of-mouth. It should be written, but it isn't, so I'm trying to work with some management and neonatology folks to change this, not just for glucose, but for all VS.

(Occasionally we do get a kid transferred from NICU that will have a couple ac glucose checks and those generally have handwritten call parameters.)

[Humbled_Nurse]

I think this is where critical thinking skills come into play. Yes, having a blood sugar of 42 in the first few hours after birth can be okay, but after 24 hours this is not okay. If a baby had some blood sugar issues initially because Mom was diabetic or baby was IUGR, preterm, etc... then blood sugar issues are very common those 1st 24 hours and they should be correctable with feedings, but if the blood sugar isn't resolved by 24 hours then the baby needs to be in the NICU for closer monitoring. If it is a baby that isn't at risk for blood sugar problems and like you said previously you decided to check a blood sugar at 26 hours of age because he is "jittery" and you get a result of 42 the physician needs to be contacted because something else may be going on like sepsis, etc....There really shouldn't be a need to have anything "written" about when to call the doctor about a low glucose after 24 hours. The nurse should know that it isn't normal and the doctor needs to be notified.

I hope this makes sense.

Hope this helps some.

[Elvish, BSN, DNP, RN, NP]

I think this is where critical thinking skills come into play. Yes, having a blood sugar of 42 in the first few hours after birth can be okay, but after 24 hours this is not okay. If a baby had some blood sugar issues initially because Mom was diabetic or baby was IUGR, preterm, etc... then blood sugar issues are very common those 1st 24 hours and they should be correctable with feedings, but if the blood sugar isn't resolved by 24 hours then the baby needs to be in the NICU for closer monitoring. If it is a baby that isn't at risk for blood sugar problems and like you said previously you decided to check a blood sugar at 26 hours of age because he is "jittery" and you get a result of 42 the physician needs to be contacted because something else may be going on like sepsis, etc....There really shouldn't be a need to have anything "written" about when to call the doctor about a low glucose after 24 hours. The nurse should know that it isn't normal and the doctor needs to be notified.

I hope this makes sense.

*I* get all that you're saying, and it is not a problem for me. I am going to be on the phone with a physician. And this is not just a blood sugar thing. I'm talking, temp, pulse, respirations, everything. We have zero parameters for any of those. I'm trying to increase the safety of our babies here. I'd like to think we use our critical thinking skills when taking care of the mothers on our unit as well, but we still have VS call parameters.